Sjogren's Syndrome Naturopathic Protocol

Sjogren's Syndrome Naturopathic Protocol

HealthMasters Naturopath Kevin Tresize ND

This Sjogren's Syndrome Naturopathic Protocol is provided as information for patients of HealthMasters Naturopath Kevin Tresize ND as part of a treatment plan to assist patients with understanding of their treatment plan and should not be substituted for medical advise, diagnosis or treatment. It is important to note that this is a summary only and is intended to assist discussion between practitioner and patient as part of consultations. This Sjogren's Syndrome Naturopathic Protocol may be changed to suit the individual requirements of the patient and should not be substituted for medical advice, diagnosis or treatment.

Definition: Sjogren's Syndrome

Sjögren's syndrome is a systemic chronic inflammatory Th1 dominant autoimmune disorder which is characterised by immune attack on the exocrine glands that produce tears and saliva. Most individuals present with xerophthalmia (dry eyes), xerostomia (dry mouth), and parotid gland enlargement. In addition, numerous extra-glandular features may develop, such as arthralgia, arthritis, Raynaud phenomenon, myalgia, pulmonary disease, gastrointestinal disease, leukopenia, anaemia, lymphadenopathy, neuropathy, vasculitis, renal tubular acidosis, and lymphoma. About 50% of patients have cutaneous findings, such as dry skin (xeroderma), palpable and non-palpable purpura, and/or urticaria.

Primary Sjögren syndrome occurs in the absence of another underlying rheumatic disorder, or more commonly, as secondary Sjögren syndrome, which is associated with another underlying rheumatic disease (it is rheumatoid factor positive in 90% of cases), such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), or scleroderma. Given the overlap of Sjögren syndrome with many other rheumatic disorders, it is sometimes difficult to determine whether a clinical manifestation is solely a consequence of Sjögren syndrome or is due to one of its overlapping disorders.

Nine out of ten Sjögren's patients are women and the average age of onset is late 40s, although Sjögren's can occur in all age groups in both women and men. Sjögren's can damage vital organs of the body with symptoms that may plateau, worsen, or go into remission. Some people may experience only the mild symptoms of dry eyes and mouth, while others go through cycles of good health followed by severe disease.

Aetiology (Cause) / Risk factors: Sjogren's Syndrome

Major causative factors and risk factors that can contribute to the incidence of Sjögren's syndrome include

  • Genetic predisposition
  • Environmental factors including bacterial or viral infection and hormonal status
  • Female gender – strikes women in a 3:1 ratio to men
  • Typically ages 30 to 60, although occurs at all ages
  • High systemic toxic load due to leaky gut, heavy metal toxicity, etc

Signs and Symptoms: Sjogren's Syndrome

Common signs and symptoms of Sjögren's syndrome include:

  • The hallmark symptoms of the disorder are dry mouth and dry eyes.
  • In addition, Sjögren's syndrome may cause skin, nose, and vaginal dryness, and may affect other organs of the body, including the kidneys, blood vessels, lungs, liver, pancreas, and brain.
  • Blurred vision with constant eye discomfort
  • Recurrent sensation of sand or gravel in the eyes
  • Recurrent mouth infections
  • Swollen parotid glands
  • Hoarseness
  • Difficulty in swallowing and eating
  • Frequently drink liquids to aid in swallowing dry food
  • Debilitating fatigue
  • Joint pain

Core Treatment: Sjogren's Syndrome

As Sjögren’s Syndrome usually occurs with other Autoimmune Diseases refer to Autoimmune Diseases or specific condition protocols

Reduce inflammation and pain

Specialised Pro-Resolving Mediators[1] - 1 capsule twice daily

If pain is chronic or arthritic:

Highly Bioavailable Palmitoylethanolamide (PEA) With Endocannabinoid Action - 1 capsule twice daily

Regulate systemic immunity, increase T-regs and modulate immune response

If with low vitamin D (Ideal levels 100-150 nmol/l):
Vitamin D3 Capsules or Liquid - 1-4 capsules or 0.25-1mL daily

Support digestion, restore gut health, manage microbial load and optimise detoxification

Metagenics Clinical Detoxification Program

Stimulate immunity if with chronic or recurrent infection 

AHCC and Ginger2 capsules twice daily

Address dietary and lifestyle factors (manage the terrain)

If stressed &/or depressed:

Assess neurobiology using the Mood and Stress Questionnaire (MSQ)

For general management:

Wellness and Healthy Ageing Program

Alphabetical Reference of Nutritional Support: Sjogren's Syndrome

Formula Catch Phrase

Key Benefits

AHCC and Ginger

Active hexose correlated compound (AHCC), an extract from Lentinula edodes (shiitake), and Zingiber officinale (ginger) support the immune system in infectious conditions. These constituents are also beneficial for management of dry eyes, which is a hall mark sign of this disorder.

BCM– 95 Turmeric and Devil’s Claw to Treat Chronic Inflammation

A combination of herbs to provide powerful long-term synergistic anti-inflammatory and analgesic effects by inhibiting RAGE, COX-2 expression, TNF-α and NFkB.

High Bioavailability Zinc with P5P

Zinc has been shown to increase Treg number and activity, helping to modulate the immune system which is essential in auto immune conditions

Highly Bioavailable Palmitoylethanolamide (PEA) With Endocannabinoid Action

PEA is a bioactive lipid that directly modulates endocannabinoid signalling, indirectly increasing cannabinoid receptor activity throughout the nervous system, including microglial cells and astrocytes, as well as receptor activity in immune cells. PEA’s actions enhance anti-neuroinflammatory, analgesic and neuroprotective pathways, benefiting chronic pain, including neuropathic pain, in addition to neurodegenerative conditions.

High Bioavailability Zinc with Vitamin C

Zinc and vitamin C are amongst the most critical nutrients in healthy immunity, as both are involved in wound healing, immune balance and boosting resistance to infection.

Lactobacillus paracasei LP-33 and Lactobacillus rhamnosus (LGG) for Immune Control

Two probiotic strains which help restore immune control and moderate over-active immune responses. These strains assist immune regulation by supporting Treg cell function and increasing anti-inflammatory cytokines such as IL-10.

Lactobacillus plantarum (HEAL 9); Lactobacillus paracasei (8700:2) and Lactobacillus rhamnosus (LGG) to Boost Immunity

Probiotics are known to help stimulate and regulate immunity and promote Th1/Th2 balance, thereby promoting resistance to infection. This is a unique combination of probiotics for patients requiring immune stimulation, particularly for those with immune insufficiency, chronic recurrent infections, post viral immune depletion and other conditions associated with low immunity. This combination enhances a variety of immune responses, including Treg and FOXP3 expressing cells, as well as increasing NK cells and phagocytosis.

Specialised Pro-Resolving Mediators

SPMs are lipid mediators that promote resolution, reduce pain, encourage clearance of pathogens and mitigate pathological inflammation, without immunosuppression. SPMs regulate macrophage polarisation; triggering the switch from M1 (proinflammatory) to the M2 (anti-inflammatory) phenotype, therefore promoting resolution.

Vitamin D3

Vitamin D is essential for immune defence, as it stimulated antimicrobial peptides and WBC activity against pathogens, recruits immune defences (Th1/Th2 responses), shown to be preventative in recurrent infections and auto-immunity.

Diet and lifestyle: Sjogren's Syndrome

Comprehensive dietary and lifestyle advice is outlined in the Wellness and Healthy Ageing Program. These principals help to establish and maintain a healthy terrain:

  • Wellness Diet: Excessive animal protein, simple sugars, gluten, casein, and food additives/chemicals have been shown to alter the inflammatory potential of the entire system and to dysregulate immunity. A diet to manage autoimmunity will be based on natural unprocessed foods, with adequate protein and essential fatty acids to supply ample prebiotic compounds, protein for immune and hormonal health and essential fatty acids supports probiotic growth.
  • Exercise: The goal is to achieve moderate exercise; that is lasting for at least 40 minutes, 4 or more times per week. Studies show that people that sit for more than 10 hours a day and do little activity, or who over-exercise, such as endurance athletes, are prone to immune suppression.
  • Detoxification: The Metagenics Clincal Detoxification Programs are designed to address the primary source of toxicity in patients, and encourage elimination of and protection against these toxins. A questionnaire is available for patients to complete which assist the Practitioner in determining the most appropriate program.
  • Maintain a healthy weight and body composition.
  • Stress hormones (cortisol, adrenalin and nor-adrenalin) supress T-helper 1 mediated cell-mediated immunity (a key defect in immune suppression), and a favours T-helper 2 activity, as seen with humoral immunity and atopic allergy. Addressing stress is key to overcoming immune suppression.

    Supportive Lifestyle Programs: Sjogren's Syndrome

    Supportive Lifestyle Program Description

    Wellness and Healthy Ageing Program

    This program recommends a low glycaemic load diet with lifestyle recommendations for exercise, relaxation, intellectual stimulation and effective stress management – all factors associated with creating a low antigenic and anti-inflammatory environment – a healthy terrain for efficient immunity.

    Metagenics Clinical Detoxification Program

    The Metagenics Clinical Detoxification Programs reduce microbial load, restore digestive tract flora and epithelial barrier, and support the release of toxic compounds that serve to imbalance normal immune function. A questionnaire is available for patients to complete which assist the Practitioner in determining the most appropriate program. There are three programs available:

    • Health Reset
    • Gut Pathogen Elimination
    • Liver Chemical Clearance

    Pathology Tests: Sjogren's Syndrome

    Pathology Test Interpretation Guidlines

    hsCRP

    Indicator of inflammatory processes. Normal range is 0–3 mg/L.

    Erythrocyte Sedimentation Rate (ESR)

    Elevated ESR (>15mm/hr) is considered indicative of inflammatory disease – elevated in 80% of Sjogren’s patients.

    Normal Values: 3-12mm/hr

    Rheumatoid factor

    Rheumatoid factor is present in 52% of cases of primary-type Sjögren’s syndrome and in 98% of secondary-type cases. This antibody can also be elevated with other autoimmune conditions.

    Normal value is <30 IU/L.

    Auto-Antibodies

    Anti-SS-A and anti-SS-B antibodies are present in most cases of primary-type Sjögren’s syndrome, while anti-salivary duct antibodies are present in most cases of the secondary type.

    Antinuclear antibodies of the speckled and homogeneous type are present in most cases of primary Sjögren’s syndrome. These antibodies also are not exclusive to this disease.

    Full blood count

    A mild normochromic normocytic anaemia is present in 50% of patients. Leukopenia occurs in up to 42% of patients

    Hair Metal Analysis

    Useful for screening for metal toxicity, which may be a triggering factor.

    Omega-3 Index Test

    A validated test that measures red-blood cell (RBC) EPA and DHA status to personalise supplemental and diet prescriptions, as well as identifying those at risk of health conditions associated with omega-3 deficiency. An Omega-3 Index in the desirable range of 8%-12% is an indicator of better overall health.

    Pharmaceutical Treatments: Sjogren's Syndrome

    • Moisture replacement therapies: such as artificial tears may ease the symptoms of dry eyes (some patients with more severe problems use goggles to increase local humidity or have punctal plugs inserted to help retain tears on the ocular surface for a longer time). Salivary aids such as sugarless chewing gums and salivary substitutes may be used, along with pilocarpine, a cholinergic parasympathomimetic agent, which may increase salivary flow.

    • Nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol: may be used for arthralgias. Gastrointestinal side effects are common and may include ulcers and bleeding.
    • Disease-modifying agents: may be used in treating arthritis and other organ manifestations. For example, hydroxychloroquine (Plaquenil), may be useful in treating arthralgias and skin symptoms, but it has not been shown to affect salivary or lacrimal gland function. The alkylating agent, cyclophosphamide, is similarly used for organ disease. Other agents may be used for Rheuamatoid arthritis with Sjogren’s. Side effects of these agents may be significant and include corneal and retinal changes, gastrointestinal symptoms, myelosuppression, and hepatotoxicity.
    • Corticosteroids (glucocorticoids): prescribed because they have both anti-inflammatory and immunosuppressive effects. Drugs such as prednisone and methylprednisolone relieve symptoms quickly and may be given orally or by injection.

    Footnotes

    [1] Ensuring patients maintain an omega 3 index above 8% is essential to SPM production. Omega-3 status can be evaluated/monitored using the Omega-3 Index Test (refer to pathology testing section). In the instance of deficiency, consider co-prescribing an omega-3 essential fatty acid supplement.

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